- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,549.93 / $16,982.44
| Facility | | $4,570.88 | $9,549.93 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $14,454.40 / $16,595.87
| Facility | | $8,317.64 | $14,454.40 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,888.44 / $28,840.32
| Facility | | $1,000.00 | $5,888.44 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $8,709.64 / $13,803.84
| Facility | | $1,202.26 | $8,709.64 | $13,803.84 |